title: Improving health information systems for decision making across five sub-Saharan African countries: Implementation strategies from the African Health Initiative.
abstract: BACKGROUND
  Weak health information systems (HIS) are a critical challenge to reaching the health-related Millennium Development Goals because health systems performance cannot be adequately assessed or monitored where HIS data are incomplete, inaccurate, or untimely. The Population Health Implementation and Training (PHIT) Partnerships were established in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze advances in strengthening district health systems. Interventions were tailored to the setting in which activities were planned.
  All five PHIT Partnerships share a common feature in their goal of enhancing HIS and linking data with improved decision-making, specific strategies varied. Mozambique, Ghana, and Tanzania all focus on improving the quality and use of the existing Ministry of Health HIS, while the Zambia and Rwanda partnerships have introduced new information and communication technology systems or tools. All partnerships have adopted a flexible, iterative approach in designing and refining the development of new tools and approaches for HIS enhancement (such as routine data quality audits and automated troubleshooting), as well as improving decision making through timely feedback on health system performance (such as through summary data dashboards or routine data review meetings). The most striking differences between partnership approaches can be found in the level of emphasis of data collection (patient versus health facility), and consequently the level of decision making enhancement (community, facility, district, or provincial leadership).
  
  
  CONCLUSIONS
  Design differences across PHIT Partnerships reflect differing theories of change, particularly regarding what information is needed, who will use the information to affect change, and how this change is expected to manifest. The iterative process of data use to monitor and assess the health system has been heavily communication dependent, with challenges due to poor feedback loops. Implementation to date has highlighted the importance of engaging frontline staff and managers in improving data collection and its use for informing system improvement. Through rigorous process and impact evaluation, the experience of the PHIT teams hope to contribute to the evidence base in the areas of HIS strengthening, linking HIS with decision making, and its impact on measures of health system outputs and impact.
authors.affiliation: Centre for Infectious Disease Research in Zambia, Zambia. wmutale@yahoo.com
authors.forename: Wilbroad
authors.initials: W
authors.lastname: Mutale
authors.forename: Namwinga
authors.initials: N
authors.lastname: Chintu
authors.forename: Cheryl
authors.initials: C
authors.lastname: Amoroso
authors.forename: Koku
authors.initials: K
authors.lastname: Awoonor-Williams
authors.forename: James
authors.initials: J
authors.lastname: Phillips
authors.forename: Colin
authors.initials: C
authors.lastname: Baynes
authors.forename: Cathy
authors.initials: C
authors.lastname: Michel
authors.forename: Angela
authors.initials: A
authors.lastname: Taylor
authors.forename: Kenneth
authors.initials: K
authors.lastname: Sherr
mesh_terms: D017954:Africa South of the Sahara; D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D063005:Health Information Systems / Q000295:instrumentation / Q000592:standards*; D058996:Quality Improvement / Q000458:organization & administration*